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12  h for 3  days and finally 50  mg hydrocortisone every   shock and unresponsive to fluids and vasopressor
                       [9]
          24 h for 3 days)  or placebo groups. The results indicated   administration.
          no  significant  difference  in  mortality  between  treatment   Review of the literature indicates the need to conduct
          and the placebo group. But shock reversal was achieved   carefully planned clinical trials to resolve controversies
          more quickly in treatment group compared to the placebo   and to provide a more reliable result. [13]
          group, regardless of the adrenal function (P  =  0.001).
          However, the proportion of patients, in whom shock   Financial support and sponsorship
          reversal was achieved, was similar between the 2 groups.   Nil.
          There was also evidence of increased risk of superinfection
          in treatment group  (combined odds ratio: 1.37; 95%   Conflicts of interest
          confidence interval: 1.05‑1.79). The strength of the study   There are no conflicts of interest.
          was its large sample size, randomization and power of
          study was 80%. The limitation of this study is that the   REFERENCES
          treatment group received steroids as late as 72 h. Earlier
          studies have shown that steroids have been beneficial only   1.   Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM,
          if given early (< 8 h). [9]                             Sibbald WJ. Definitions for sepsis and organ failure and guidelines for the use
                                                                  of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference
          All meta‑analysis confirmed improved shock reversal with   Committee. American College of Chest Physicians/Society of Critical Care
                  [3]
          LDC  use.   Subsequent  analysis  found that  severely  ill   2.   Medicine. Chest 1992;101:1644‑55.
                                                                  Yarema TC, Yost S. Low‑dose corticosteroids to treat septic shock: a critical
          patients were more likely to benefit from corticosteroid   literature review. Crit Care Nurse 2011;31:16‑26.
          therapy. One analysis suggested that it may be harmful in   3.   Gesensway D. Why steroids are making a comeback for treating septic shock.
          less ill patients. [3]                                  Todays Hospitalist 2006;5. Available from: http://www.todayshospitalist.com/
                                                                  index.php?b=articles_read and cnt=176. [Last accessed on 2014 Jun 02].
          While on steroids, according to a previous study done,    4.   David KA, Mancebo J. Corticosteroid Therapy in septic shock. UpToDate
                                                         [10]
          there was a certain  increase  in side  effects of secondary   2014;1. Available  from:  http://www.uptodate.com/contents/corticosteroid‑
          infections, gastrointestinal bleeding and increased blood   5.   therapy‑in‑septic‑shock. [Last accessed on 2015 Jan 11].
                                                                  Hamrahian AH, Oseni TS, Arafah BM. Measurements of serum free cortisol
          glucose. However, these problems could  be due to       in critically ill patients. N Engl J Med 2004;350:1629‑38.
          terminal  illness.  This  probably  indicates  the  need  for a   6.   Annane D, Sébille V, Charpentier C, Bollaert PE, François B, Korach JM,
          larger clinical trial. [2]                              Capellier G, Cohen Y, Azoulay E, Troché G, Chaumet‑Riffaud P, Bellissant E.
                                                                  Effect of treatment with low doses of hydrocortisone and fludrocortisone
          Current recommendations [3,11,12]  suggest:             on mortality in patients with septic shock. JAMA 2002;288:862‑71.
          •  Administering  intravenous  corticosteroid  therapy   7.   Keh D, Boehnke T, Weber‑Cartens S, Schulz C, Ahlers O, Bercker S, Volk HD,
             (200‑300 mg/day) to adult patients with severe septic   Doecke WD, Falke KJ, Gerlach H. Immunologic and hemodynamic effects
             shock (defined as a systolic blood pressure less than   of “low‑dose” hydrocortisone in septic shock: a double‑blind, randomized,
                                                                  placebo‑controlled, crossover study.  Am J Respir Crit Care Med 2003;167:512‑20.
             90 mmHg for more than 1 h despite both adequate fluid   8.   Sprung CL, Annane D, Keh D, Moreno R, Singer M, Freivogel K, Weiss YG,
             resuscitation and vasopressor administration);       Benbenishty J, Kalenka A, Forst H, Laterre PF, Reinhart K, Cuthbertson BH,
          •  Not administering the corticosteroid to patients without   Payen D, Briegel J; CORTICUS Study Group. Hydrocortisone therapy for
             shock or patients with less severe shock (defined as those   9.   patients with septic shock. N Engl J Med 2008;358:111‑24.
                                                                  Toma A, Stone A, Green RS, Gray S. Steroids for patients in septic shock:
             in whom fluid resuscitation and vasopressor therapy have   the results of the CORTICUS trial. CJEM 2011;13:273‑6.
             restored hemodynamic instability);               10.  Cronin L, Cook DJ, Carlet J, Heyland DK, King D, Lansang MA, Fisher CJ Jr.
          •  ACTH test prior to administering steroids in sepsis is not   Corticosteroid treatment for sepsis: a critical appraisal and meta‑analysis of
             recommended;                                         the literature. Crit Care Med 1995;23:1430‑9.
          •  Typically administer hydrocortisone for 57 days and taper   11.  Gandhi NR, Asudani DG. What is the role of steroids in septic shock?
                                                                  Hospitalist 2012;5. Available from: http://www.the‑hospitalist.org/article/
             the dose as guided by the clinical response.         what‑is‑the‑role‑of‑steroids‑in‑septic‑shock/. [Last accessed on 2015 Jan 11].
                                                              12.  Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, Sevransky JE,
          The  impairment  of hypothalamic‑pituitary‑adrenal  axis  in   Sprung CL, Douglas IS, Jaeschke R, Osborn TM, Nunnally ME, Townsend SR,
          sepsis has not been resolved yet.                       Reinhart  K,  Kleinpell  RM, Angus  DC,  Deutschman  CS,  Machado  FR,
                                                                  Rubenfeld GD, Webb SA, Beale RJ, Vincent JL, Moreno R; Surviving Sepsis
          The most uniform finding by almost all trials is that   Campaign Guidelines Committee including the Pediatric Subgroup. Surviving
          corticosteroid  may accelerate shock reversal.  At  this   sepsis campaign: international guidelines for management of severe sepsis
                                                                  and septic shock: 2012. Crit Care Med 2013;41:580‑637.
          time, the most supported view is LDC should be      13.  Vincent JL. Steroids in sepsis: another swing of the pendulum in our clinical
          administered to those patients who are in septic        trials. Crit Care 2008;12:141.
















          Plast Aesthet Res || Vol 2 || Issue 5 || Sep 15, 2015                                             285
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